Low triiodothyronine predicts mortality in critically ill patients

Abstract

Objective:Alteration in thyroid hormones are seen in critically ill patients admitted to intensive care units. Our objective was to study the thyroid hormone profile, prolactin and, glycosylated hemoglobin (HbA1c) at admission and analyze their correlation with mortality.Materials and Methods:In this single centre, prospective, observational study, 100 consecutive patients (52M; 48F) admitted to medical ICU irrespective of diagnosis were included. Patients with previous thyroid disorders and drugs affecting thyroid function were excluded. All participants underwent complete physical examination and a single fasting blood sample obtained at admission was analyzed for total triiodothyronine (T3), total thyroxine (T4), thyroid stimulating hormone (TSH), HbA1c, and prolactin. The patients were divided into two groups: Group 1 – survivors (discharged from the hospital) and Group 2 – nonsurvivors (patients succumbed to their illness inside the hospital). The data were analyzed by appropriate statistical methods and a P-value of <0.05 was considered significant.Results:The mean age of the participants was 58.7 ± 16.9 years and the mean duration of ICU stay was 3.3 ± 3.1 days. A total of 64 patients survived, whereas remaining 36 succumbed to their illness. The baseline demographic profile was comparable between survivors and nonsurvivors. Nonsurvivors had low T3 when compared with survivors (49.1 ± 32.7 vs. 66.2 ± 30.1, P = 0.0044). There was no significant difference observed between survivors and nonsurvivors with respect to T4, TSH, HbA1c, and prolactin.Conclusion:Our study showed that low T3 is an important marker of mortality in critically ill patients. Admission HbA1c, prolactin, T4, and TSH did not vary between survivors and nonsurvivors.

Outcome Predictors in Patients Presenting With Acute Aortic Dissection

“…15,16 The pathophysiologic mechanism underlying the association between T3 and critical illness has not been elucidated fully; it generally is considered an adaptive self-protective physiologic response rather than a maladaptive response requiring treatment. 7 Nevertheless, T3 and acute aortic dissection outcomes have not been reported previously. Gutierrez et al 17 reported that T3 level was not changed in aortic dissection patients, but both acute and chronic aortic dissection patients were enrolled in this small sample size (n ¼ 28) research, and the relationship between T3 and clinical outcome was not investigated.…”

“…Triiodothyronine (T3) is a well-known risk factor in multiple clinical scenarios. It was first reported in critically ill patients admitted to intensive care units (ICUs) 7 and now can be found in various life-threatening conditions, such as respiratory failure, acute myocardial infarction, severe sepsis, trauma, etc. [8][9][10][11][12] Under such critical conditions, thyroid hormone metabolism can be profoundly changed in patients without previously diagnosed intrinsic thyroid disease, including low serum triiodothyronine (T3) level, normal or low thyroxine (T4) level, and normal or low thyroid-stimulating hormone (TSH) level.…”

Study of thyroid function in patients admitted in intensive care unit in a tertiary care centre

“…T4 and TSH did not vary between survivors and nonsurvivors. 5 Whereas other researchers showed that there was no association. 6 Therefore, undertook study of medical ICU patients to detect the independent predictors of ICU mortality on the basis of thyroid hormone levels (TT3, TT4, TSH,) and to evaluate the ability of thyroid hormone level to predict ICU mortality.…”

Role of Thyroid Biomarkers in Association With Sofa Score in Predicting the Prognosis of Post-Operative Critically Ill Patients

“…Various studies have reported that nonsurvivors had very low thyroid biomarkers as compared to the survivors. [27][28][29] Although, most of the studies suggest definite association between thyroid dysfunction and worse outcome in sepsis, the findings are inconsistent and need further investigation. 30 In our study we observed the average serum FT3 level 1.73 ± 0.31 pg/mL in HSS group, while it was 2.03 ± 0.22 pg/mL in LSS group, though both the reading are in normal range; however, in HSS group it was significantly on lower side (p= 0.004; Figure 1a).…”

“…23 Low level of thyroid hormone is correlated with severity of illness along with SOFA in various studies. [24][25][26][27][28][29] Therefore, this observational study was intended to detect the thyroid biomarkers (FT3, FT4 and TSH) as independent predictors of ICU mortality in unselected post-operative patients. This study may be helpful in adding one more parameter to define the prognosis of these critically ill post-operative patients with sepsis along with SOFA, APACHE II and others.…”